States face a deadline at the end of this week to decide whether they want to create their own health insurance exchange, or leave it to the federal government to set up the framework.

Editors at the Greensboro News & Record[1] spell out why it’s time for North Carolina lawmakers to stop dragging their feet and embrace their role in implementing the Affordable Care Act.

Here’s more from the paper’s Thursday editorial:

….So the next step is to make it possible for people without health insurance to get it at a cost they can afford. That’s where health insurance exchanges come in. States are asked to set up exchanges, propose partnerships with the federal government, or let Washington do it for them.[2]

Again, Republican legislators resisted. Although they expressed an “intent” for North Carolina to run its own exchange, they have not created a governing structure. Instead, they apparently bet on the election of Mitt Romney, who pledged to “repeal Obamacare” as his first order of business. American voters eliminated that possibility last week.

Now it’s decision time. The state must officially indicate by Friday whether it intends to operate its own exchange.

An exchange is a virtual market that lets consumers, who don’t have coverage elsewhere, choose from among several health care plans. It provides premium subsidies for people who qualify for help. Each plan comes with minimum coverages, and no one can be excluded for pre-existing conditions.

Despite legislative recalcitrance, some state leaders have been preparing for a state role. Newly re-elected Insurance Commissioner Wayne Goodwin has administered a federal planning grant and worked with the N.C. Department of Health and Human Services and the North Carolina Institute of Medicine to establish a blueprint for a state exchange. And Gov.-elect Pat McCrory, a pragmatic Republican, has indicated a desire for North Carolina to have a hand to implementing the Affordable Care Act.

Goodwin believes leaving the job to the federal government is “unacceptable. North Carolina is not California, Idaho or New Hampshire. We need to start taking care of ourselves,” he said Tuesday.

That means providing the regulatory framework for the program and overseeing consumer protection, while federal grants cover the costs.

Unfortunately, Goodwin added, “the shot clock has pretty much run out unless the clock is rewound.” The General Assembly hasn’t passed enabling legislation, so the state probably will yield control initially to the feds. It should try to take a larger role as soon as possible, but it may be locked in to a system it wouldn’t choose for itself.

That’s too bad. The political and legal battles are over. This is about giving North Carolina residents better access to health care. The state should do it right.